Do you know more than 10% of the 150,000 providers in Texas are yearly violating Texas timely billing law and losing thousands of dollars in penalties? Many providers are not intentionally violating the law, but a large number are unaware of the direct patient medical billing time limits set by the state of Texas. This unawareness about the Texas timely billing law and billing limits leads to violations and results in payment loss and inefficient revenue cycle management. This blog provides comprehensive information on the Texas timely billing law and what are the penalties for providers who don’t follow this law so you can avoid them and maintain your revenue.  

What Is The Texas Timely Billing Law for Direct Patient Billing?

The Texas Timely Billing Law for patient billing is outlined in Chapter 146 of the Texas Civil Practice and Remedies Code* and is designed to ensure that healthcare providers send bills to patients in a reasonable timeframe. It requires healthcare providers to bill patients for services no later than the first day of the 11th month which is approximately 10 months after the service date. If a provider fails to send the bill within this timeframe, they lose the right to collect certain charges from the patient.

Here are the key aspects of the Texas timely billing law:

1. Billing Deadline

In Texas, medical providers must send the bill to the patient or responsible person by the first day of the 11th month after the service was given. This rule applies whether they are billing the patient directly or through an insurance company or government program like Medicaid or Medicare. If they miss this deadline, they can’t ask for payment.   

2. Time Limit by Insurance and Third-Party Payors

If the provider is billing an insurance company or another third party (such as Medicare or Medicaid), they must follow the timeline set by the contract or federal Texas law on unpaid medical bills. If there is no specific deadline in these contracts, the provider still has until the 11th month after the service date to submit the bill. 

In short, this law ensures that patients will never be surprised by late medical bills in Texas, and it provides a clear deadline for when charges must be submitted, protecting both patients and those responsible for their medical bills. 

What Are the Penalties for Not Following Texas Timely Billing Law for Billing Patients?

The penalties for not following the Texas Timely Billing Law for billing patients are primarily financial, and they focus on protecting patients from being unfairly billed for medical services.

Here’s a detailed breakdown of the penalties when you file late according to the medical billing time limits by state of Texas:

1. Inability to Recover Payment from the Patient (Section 146.003)

If a healthcare provider does not bill a patient or their insurer within the required timeframe of Texas law on unpaid medical bill collections (10 months from the date of service), the provider loses the right to recover certain payments. Specifically, the provider cannot collect:

• Any amount the patient would have been reimbursed by their insurance.
• Any amount the patient would not have been required to pay if the provider had billed on time.

This means that for any provider that fails to observe the 10-month medical billing period appointed by the state, the right to charge in that period for services provided is usually waived to both the patient and their insurer. This may lead to severe financial losses on the part of the provider since the provider will not be in a position to demand payment for the services that need to have been billed in time.

2. Cannot Seek Payment from Family or Other Responsible Parties (Section 146.003(b))

If a provider misses the billing deadline, they can’t ask the patient or anyone else, like a family member, to pay the bill. Once the Texas Timely Billing Law is violated, the provider loses the right to collect the unpaid amount from anyone, no matter who might have been responsible for the payment.

3. No Disciplinary Action (Section 146.004)

Although there are significant financial consequences for not following the Texas Timely Billing Law, the provider does not face any professional disciplinary actions. Violating the billing law does not affect their medical license or other legal authority to practice. In other words, the provider won’t be penalized by state licensing boards or face legal disciplinary measures for failing to meet the timely billing requirement. This focuses on the consequences of financial losses rather than professional ones.

The Importance of Texas Timely Billing Law

This law is meant to protect patients from getting surprise or late medical bills. It makes sure that healthcare providers send bills on time, so patients don’t have to worry about being charged for services months after they were treated. If providers don’t follow the Texas Timely Billing Law, then they forfeit reimbursement and can’t charge the patient. This pushes them to stick to the rules and bill promptly.

How to Avoid Texas Timely Billing Penalties?

To protect yourself from late billing penalties, you can outsource to a medical billing company in Texas like Transcure. We are experts in handling all aspects of Texas medical billing, ensuring that your claims are filed on time and accurately right according to the medical billing time limits by state. By outsourcing to us, you avoid the risks of missing important deadlines, like the 10-month rule in Texas, which can lead to financial losses if not followed. Our medical billing services in Texas will manage the entire process, including tracking claims, following up with insurance, and making sure everything is submitted correctly and on time. This way, you can focus on patient care while we take care of your billing.

Conclusion

In conclusion, the Texas Timely Billing Law determines how long does doctor have to bill you. It makes sure that healthcare providers send bills within 10 months of providing services. If they miss this deadline, they cannot collect payment from the patient or their family. While the provider faces financial loss, they will not lose their medical license or face other penalties. This law is designed to protect patients from surprise or late bills and encourages providers to bill on time. If you are a busy provider, you can get help from professional medical billing companies in Texas because they stay compliant with all the state’s billing guidelines and limits. 

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